Abstract

Background

Cerebral venous outflow obstruction involves idiopathic intracranial hypertension, and the most common related condition is dural venous sinus stenosis or, in other words, an obstruction of the dural venous sinuses. In these cases, the pathological process is often chronic, displays only mild symptoms, and rarely requires urgent surgical intervention. In this study, we present a unique case involving an acute cerebral venous outflow obstruction that occurred during meningioma resection that ultimately had catastrophic consequences.

Materials and methods

The patient's preoperative imaging only revealed an unremarkable frontal convexity meningioma with an average diameter exceeding 8 cm. She was admitted for a scheduled right frontoparietal craniotomy for lesion resection.

Results

The patient's unique congenital dural venous sinus structure along with a non-surgical epidural hematoma both contributed to a catastrophic outcome, causing a progressive hemispheric encephalocele, significant blood loss, and wound closure difficulties.

Conclusion

Neurosurgeons should place an additional focus on cerebral venous outflow patency during tumor resection, even if the tumor does not involve the transverse or sigmoid sinuses. It is well known that the tacking sutures play an essential role in preventing an epidural hematoma, but the procedure to mitigate hematomas occurring outside the surgical field of view is not fully recognized by neurosurgeons. If dural tacking sutures are placed after complete tumor resection, the prophylactic effect for preventing EDH in the non-surgical areas may not be guaranteed. Therefore, we strongly advocate for the tacking sutures to be accurately placed before dural incisions are made.

中文翻译：

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凸面脑膜瘤切除术中急性脑静脉流出道梗阻

摘要

背景

脑静脉流出道阻塞涉及特发性颅内高压，最常见的相关病症是硬脑膜静脉窦狭窄，或者换句话说，硬脑膜静脉窦阻塞。在这些情况下，病理过程通常是慢性的，仅表现出轻微的症状，很少需要紧急手术干预。在这项研究中，我们提出了一个独特的案例，涉及脑膜瘤切除期间发生的急性脑静脉流出道阻塞，最终导致灾难性后果。

材料和方法

患者术前影像学检查仅显示平均直径超过 8 cm 的额部凸面脑膜瘤，无异常。她因预定的右侧额顶开颅术而入院，以切除病灶。

结果

患者独特的先天性硬脑膜静脉窦结构以及非手术硬膜外血肿均导致灾难性后果，导致进行性半球脑膨出、大量失血和伤口闭合困难。

结论

即使肿瘤不涉及横窦或乙状窦，神经外科医生也应在肿瘤切除期间额外关注脑静脉流出道的通畅情况。众所周知，缝合线在预防硬膜外血肿方面发挥着重要作用，但神经外科医生并未完全认识到减轻手术视野外发生的血肿的程序。如果在完全切除肿瘤后放置硬脑膜缝合线，则可能无法保证预防非手术区EDH的预防效果。因此，我们强烈主张在进行硬脑膜切口之前准确放置缝合线。